Angina Bullosa Hemorrhagica Clinical Presentation

Updated: Dec 15, 2017
  • Author: Kara Melissa T Torres, MD, DPDS; Chief Editor: Dirk M Elston, MD  more...
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Presentation

History

Angina bullosa hemorrhagica (ABH) is characterized by its sudden onset during or just after eating. [8] The lesions may be preceded by stinging pain or a burning sensation, but they are essentially asymptomatic. [5] A large bullae in the palatal region has been reported to give rise to a feeling of suffocation. [22] Occasionally, patients may present with hoarseness or blood-tinged sialorrhea. [5]

The blisters may last from a few minutes to 24-48 hours and then spontaneously rupture, typically during meals, releasing blood into the mouth. It usually leaves an erosion covered by epithelial slough that heals without scarring, discomfort, or pain within a week’s time. [6] The lesions may appear intermittently or at regular intervals. The cases reported had a duration ranging from 4 months [21] to 25 years. [19]

Patients do not report a tendency to bleed at other sites.

Family history generally is noncontributory to angina bullosa hemorrhagica. Grinspan et al [23] reported that 44% of his patients in a series of 24 cases published in 1999 had from type II diabetes, hyperglycemia, or family history of diabetes. No conclusive evidence of a cause-and-effect relationship exists between the presence of angina bullosa hemorrhagica and glucose metabolism.

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Physical Examination

The blister of angina bullosa hemorrhagica (ABH) appears tense, dark red to purple in color, and blood-filled surrounded by an ecchymotic halo. It has an average size of 1-3 cm in diameter. [5] They are often solitary, but multiple lesions have been described. [21]

Note the images below.

A 42-year-old man with the sudden appearance of an A 42-year-old man with the sudden appearance of angina bullosa hemorrhagica. The patient experienced pain a few minutes before the bulla appeared. He had a history of 3 similar previous episodes at the same site. Because the lesions only stay intact for a short duration, the patient took the picture using his own cellular phone.
A 42-year-old man with the sudden appearance of an A 42-year-old man with the sudden appearance of angina bullosa hemorrhagica. The patient experienced pain a few minutes before the bulla appeared. He had a history of 3 similar previous episodes at the same site. Because the lesions only stay intact for a short duration, the patient took the picture using his own cellular phone. Image shows 24 hours after the initial presentation of angina bullosa hemorrhagica.

The soft palate is the most commonly affected site in angina bullosa hemorrhagica. [17] Occasional lesions have been reported in the buccal mucosa, alveolar ridge, [19] tongue, hard palate, [18] and, rarely, the gingiva. [13] If located on the tongue, the anterior third is most commonly affected. The vermillion border of the lips are almost always spared. [23] Angina bullosa hemorrhagica also may involve the pharynx and the esophagus. [18] Approximately one third of the patients exhibit lesions in more than one location.

Similar lesions in other mucous membranes or the skin have not been reported.

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Complications

There is a remote risk of asphyxia with palatal or pharyngeal lesions. [5]

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